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Click ‘Get Form’ to open the Mumps Varicella Measles Rubella - Whittier Medical Services form in the editor.
Begin by entering the name of your school in the designated field at the top of the form.
For each student or instructor listed, fill in their name under 'STUDENT/ INSTRUCTOR NAME'.
Complete the vaccination sections by indicating whether each student has received vaccinations for Influenza, Hepatitis B, TDAP, and Varicella. Use 'Vaccination' or 'Declination' as appropriate.
If applicable, enter titer results for Hepatitis B and Varicella in the provided fields.
Document completion dates for each vaccination or declination in the corresponding columns.
Ensure all required screenings (Tuberculosis, Drug Screen, Background Screen) are noted as completed.
Finally, have a school representative sign and date the form at the bottom to acknowledge compliance.

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What is measles, mumps, rubella, and varicella?

Measles, mumps, rubella and varicella (chickenpox) are highly contagious viral infections. They can easily spread among unvaccinated people. These viral infections are often mild. But in some people they can lead to serious complications, including meningitis.

Can you get the measles, mumps and rubella vaccine separately?

There is no evidence that using separate vaccines to immunise children against these childhood diseases is either safe or effective, because this type of regimen has never been used anywhere in the world, write Professor David Elliman of St Georges Hospital, London, and Dr Helen Bedford of the Institute of Child

What does MMR stand for?

PRIORIX is a combination measles, mumps, and rubella (MMR) vaccine manufactured by GlaxoSmithKline Biologicals (GSK).

How many MMR measles, mumps, rubella vaccinations are required?

In the U.S., the Centers for Disease Control and Prevention (CDC) recommends that children get two doses of the MMR vaccine. Children can receive their first dose between 12 and 15 months old and the second dose between 4 and 6 years old.